COVID remote learning eroded mental health by race, age, income, data indicate

A study late last week in JAMA Network Open reveals a small link between COVID-19–related school closures and worse child mental health, particularly among older and Black and Hispanic students and those from low-income families.

University of Washington at Seattle researchers led the study, which involved an online and phone survey of 2,324 US adults 18 to 64 years old with at least one child aged 4 to 17 years from Dec 2 to 21, 2020. Parent participants, randomly selected from the AmeriSpeak panel (developed by NORC at the University of Chicago), reported child emotional, peer, conduct, and hyperactivity problems using the Strengths and Difficulties Questionnaire.

Of the 2,323 adults who completed the survey, 71.9% were women, 16.0% were Hispanic, 10.5% were Black, and 18.1% had a high school education or less.

Among children, 58.0% engaged in distance learning, while 18.0% were in a hybrid format, and 24.1% attended in person. Of children learning from home, 17.1% belonged to a learning pod, a group that completed schoolwork together, as did 29.3% of those in a hybrid model.

Older children struggle more

Relative to children attending school from home, those who attended in person came from higher-income households (mean difference, $9,719) and were more likely to be White (65.8% vs 44.5%).

One reason may be that private schools, which were more likely than public schools to be open during the pandemic, often have high proportions of White children from higher-income families, the authors said. More Black and Hispanic families may be more likely to choose distance instruction because they have higher odds of having an at-risk family member or believe that their child's school can't effectively mitigate COVID-19 risk.

Children from higher-income homes also saw more benefits from in-person education than those from lower-income families, an effect not seen with hybrid students. "It is possible that schools with more resources have smaller class sizes, closer student-teacher relationships, more school counselors per student, and consequently, a greater ability to help regulate child behavior," the authors wrote.

Older children who were engaged in distance learning had more mental health struggles than those attending classes in person, while younger students attending school remotely had similar or somewhat better mental health outcomes than those learning in person. Older children are especially vulnerable because they are in the midst of forming more complex social relationships and higher-stakes academic outcomes, the researchers wrote.

"Thus far, reopenings have prioritized younger children because of the lower transmission rates compared with older students and the relatively higher burden of care they require from working parents," the authors said. "Unfortunately, current results suggest that school closings have been disproportionately detrimental to mental health adjustment for older children, with effect sizes in the small range."

The use of learning pods lessened the effect of hybrid schooling on mental health difficulties, but the same was not observed for distance learning.

Effects of race, poverty, food insecurity

The researchers said that a host of factors related to remote education could chip away at children's mental health, including isolation, decreased access to mental health services, loss of free and reduced-cost meals, disrupted routines, decreased physical activity, lack of structure, stress due to technological limitations, and lack of identification of abuse and neglect.

For racial minorities and students from low-income families, the interruption of their schooling may be compounded by racism, poverty, food insecurity, and home instability. "Most families are struggling to support their child's at-home learning; however, challenges may be heightened among families with low income who lack workplace flexibility or the financial resources to work fewer hours or pay for child supervision," the researchers wrote.

The authors called for more funding for mental health personnel in the schools, as well as community-based supports.

"Critically, as children return to in-person instruction, mental health inequities may not resolve on their own," they concluded. "Ensuring that all students have access to additional educational and mental health resources must be an important public health priority, met with appropriate funding and work force augmentation, during and beyond the COVID-19 pandemic."

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